BackgroundData are sparse regarding the effects of prolonged prone positioning (PP) during VV-ECMO. Previous studies, using short sessions (<12 h), failed to find any effects on respiratory system compliance. In the present analysis, the effects of prolonged PP sessions (24 h) were retrospectively studied with regard to safety data, oxygenation and respiratory system compliance.MethodsRetrospective review of 17 consecutive patients who required both VV-ECMO and prone positioning. PP under VV-ECMO was considered when the patient presented at least one unsuccessful ECMO weaning attempt after day 7 or refractory hypoxemia combined or not with persistent high plateau pressure. PP sessions had a duration of 24 h with fixed ECMO and respiratory settings. PP was not performed in patients under vasopressor treatment and in cases of recent open chest cardiac surgery.ResultsDespite optimized protective mechanical ventilation and other adjuvant treatment (i.e. PP, inhaled nitric oxide, recruitment maneuvers), 44 patients received VV-ECMO during the study period for refractory acute respiratory distress syndrome. Global survival rate was 66 %. Among the latter, 17 patients underwent PP during VV-ECMO for a total of 27 sessions. After 24 h in prone position, PaO2/FiO2 ratio significantly increased from 111 (84–128) to 173 (120–203) mmHg (p < 0.0001) while respiratory system compliance increased from 18 (12–36) to 32 (15–36) ml/cmH2O (p < 0.0001). Twenty-four hours after the return to supine position, tidal volume was increased from 3.0 (2.2–4.0) to 3.7 (2.8–5.0) ml/kg (p < 0.005). PaO2/FiO2 ratio increased by over 20 % in 14/14 sessions for late sessions (≥7 days) and in 7/13 sessions for early sessions (<7 days) (p = 0.01). Quantitative CT scan revealed a high percentage of non-aerated or poorly-aerated lung parenchyma [52 % (41–62)] in all patients. No correlation was found between CT scan data and respiratory parameter changes. Hemodynamics did not vary and side effects were rare (one membrane thrombosis and one drop in ECMO blood flow).ConclusionWhen used in combination with VV-ECMO, 24 h of prone positioning improves both oxygenation and respiratory system compliance. Moreover, our study confirms the absence of serious adverse events.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-015-0078-4) contains supplementary material, which is available to authorized users.

ObjectiveEstablishing a peripheral intravenous catheter (PIVC) after a long intensive care unit (ICU) stay can be a challenge for nurses, as these patients may present vascular access issues. The aim of this study was to compare an ultrasound-guided method (UGM) versus the landmark method (LM) for the placement of a PIVC in ICU patients who no longer require a central intravenous catheter (CIVC).DesignRandomised, controlled, prospective, open-label, single-centre study.SettingTertiary teaching hospital.Participants114 awake patients hospitalised in ICU fulfilling the following criteria: (1) with a central venous catheter that was no longer required, (2) needing a PIVC to replace the central venous catheter and (3) with no apparent or palpable veins on upper limbs after tourniquet placement.InterventionPlacement of a PIVC using an UGM.Primary outcomeNumber of attempts for the establishment of a PIVC in the upper limbs.Results57 patients were respectively included in both the UGM group and LM group. Stasis oedema in the upper limbs was the main cause of poor venous access identified in 80% of patients. Both the number of attempts (2 (1–4), p=0.911) and catheter lifespan ((3 (1–3) days and 3 (2–3) days, p=0.719) were similar between the two groups. Catheters in the UGM group tended to be larger (p=0.059) and be associated with increased extravasation (p=0.094).ConclusionIn ICU patients who no longer require a CIVC, use of an UGM for the establishment of a PIVC is not associated with a reduction in the number of attempts compared with LM.Trial registration numberNCT02285712; Results.

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